1 Strategies for Serving the Chronically Homeless …

2 Citrus Health Network  Federally Qualified Health Center  Pharmacy  Medical Home  Case Management  Psychiatric Model  Out-Patient Services  Crisis Unit  STAR

3 Origin & Expansion of Housing Model  Citrus began the first HUD funded “ low demand ” residence in Miami Dade County in 1992 targeting chronically mentally ill homeless  Safe Haven & Drop-In Center  Shelter Plus Care  Specialized Outreach  Jail Diversion  Housing First  Case Rate

4 Low Demand Housing  In 1992, Citrus opened a transitional housing program which served psychiatrically disabled homeless persons with co- occurring chemical dependencies.  Designed to engage single, adults who refuse mainstream homeless programs, we had few rules

5 Safe Haven  Single bedroom design intended to engage homeless persons suffering from severe mental illnesses.  Designed to engage single, adults who refuse mainstream homeless programs, we had few rules  85% successful out-placements

6 Safe Haven  Outreach  Drop-In Center

7 S+C Approximately 300 Independent living units intended for formerly homeless, disabled adults and families Miami-Dade Housing Agency: Rent subsidy only Match requirement

8 Coordinated Outreach  Philadelphia Model  Chronic Homeless focus  Census 180 from 400, annually (40% success rate)  SOAR

9 Relationship Based Care Philosophy Relationship Based Care uses the empathy, respect and connectedness that are inherent in healthy relationships to engage individuals in therapeutic activities and empower them to take responsibility for their lives

10 Relationship Based Care Engagement Phase  May require multiple contacts & outreach in their environment  Motivational Interviewing a MET technique (Role play with the staff)  Encouraging Voluntary acceptance of services  Personal freedom & choice

11 Jail Diversion  Miami-Dade County initiative geared at diverting mentally ill individuals away from incarceration and into community-based treatment programs.  Scattered Site, Transitional Housing

12 Jail Diversion  Outcomes published in Psychiatric Services, June 2009 ed.  151 individuals served by Citrus over three years, compared to control group  Citrus clients had statistically significant reduction in criminal recidivism

13 Housing First  Pathways to Housing visit  Designed to engage chronic homeless adults who refuse existing, mainstream housing resources  ACT staffing model  97% retention rate

14 Case Rate  Menu of housing choices  Clients can move between models  Payment structure is designed to reward performance  Food and Beverage Tax